Obesity: A big issue

Britain is getting fatter – and Yorkshire is one of the fattest places in the country.

Obesity in women (at 23.8 per cent) is the second highest in the UK and things are getting worse every year.

According to the expert projections, by 2050 nearly 70 per cent of of us could be obese. And the portents for things changing do not look good.

Within Yorkshire, only 40 per cent of men and 26 per cent of women currently take enough exercise.

Our region has the fourth lowest rate of fruit and vegetable consumption in the country, with only 23 per cent of adults and 15 per cent of children eating five portions or more a day.

The implications for the NHS in terms of cost and consequences for future generations are worryingly obvious.

A total of 3,600 people in Yorkshire already die each year from obesity-related illnesses and as sedentary lifestyles, bigger portions and an increasing lack of nutritional nouse combine to take their toll on the nation's health, the medical profession is joining forces to find solutions.

A new taskforce has been set up with the aim of promoting more accessible treatment and funding to help people whose weight problems cannot be solved with a calorie chart and an exercise bike.

ESCO – Experts in Severe and Complex Obesity – is bringing together medical professionals in the fields of surgery, psychology, gynaecology , and nutrition.

One of its key aims will be to promote the availability and accessibility of radical treatment for people who are so seriously obese that their health is in serious danger.

Celebrities like Vanessa Feltz, Anne Diamond and Fern Britton have famously had to resort to gastric bands to address the issue of their lifelong weight problems. Such measures are often criticised as vanity projects which are both unnecessary and undesirable.

But Leeds-based members of the ESCO team are keen to stress that surgery is sometimes the only answer.

And, in the years ahead, they say more and more people are likely to need it.

The figures show that of the one million or so severely and morbidly obese population in the UK, there are currently 230,000 people eligible for surgery. However, fewer than two per cent of these patients will actually receive it on the NHS.

Surgeon Simon Dexter, who is based at St James's Hospital in Leeds, points out that surgery for severely obese patients is far more cost effective than the long-term treatment of chronic obesity-related illnesses.

He said: "It is absolutely not about vanity, if you are carrying a lot of extra weight then there is an increased risk of diseases like diabetes, cancer and heart disease. So there are clear financial benefits to the NHS in offering obesity surgery.

"We are getting fatter for a number of reasons. A lot of people are able to eat cheaply but that does not mean they are eating well. Our lifestyles are also a lot more sedentary than they ever were. It all adds up.

"Things have changed in the last 10 years. Then, there were very few people around the country who were involved in this kind of surgery but it has become mainstream in a lot of places.

"There are lots of surgeons with the necessary skills and the figures have shot up accordingly.

"The problem is multi-factored, but when you look at the incidence of childhood obesity it is very frightening. Our children's lifespans could be shorter than ours. We have to get people moving and teach them about food again.

"But when, as I have, you have seen so many people gain their health back via surgery, this is sometimes the only option. And it is an option which can increase life expectancy by up to 15 years."

A study carried out by the New England Journal of Medicine in 2007 showed that over 15 years, morbidly obese people who underwent non-surgical treatment showed a weight reduction of only three per cent while patients undergoing surgery lost between 13 per cent and 28 per cent of their weight.

The surgery available at Leeds General Infirmary and St James's Hospital includes procedures such as gastric banding which limits the amount of food the stomach can hold.

In addition to limiting food intake, more complex operations like gastric bypass also reduce the appetite by restoring the normal intestinal release of appetite suppressant gut hormones, which is lacking or very weak in the morbidly obese.

As the ESCO group begins its mission to make more surgical treatment available , it has already received official endorsement from the National Obesity Forum and the British Obesity and Metabolic Surgery Society

Another member of the team is clinical dietician Mary O'Kane, who since 1981 has been based in Leeds.

She said: "Obesity is a multi-faceted problem. Our eating habits have changed, there's the fact that portions are far larger than they used to be, and of course that we are walking less and eating more . We even use e-mail rather than cross the floor to speak to colleagues. It's all causing an increase in weight and big problems for the NHS.

She said: "Since I graduated in the 1980's the obesity figures have got much higher, and it's getting worse. We have got a very difficult task, but we need to be working together promoting health and teaching people basic things like cooking healthy food.

"Yorkshire and the Humber has one of the highest figures for obesity so we are bringing together people from various disciplines to tackle issues, doctors consultants surgeons and dieticians. The idea is to take the opportunity to raise awareness in our local communities and health authorities and make people aware that they need to invest in their health and that it will pay off in the long-term"

Mary agrees that surgery is in many cases the last resort. You also have to be pretty big to qualify.

Under the latest guidelines, no-one with a BMI of less than 45 is eligible for NHS treatment ( the "normal" range is between 20 and 25 ).

But, like Simon Dexter, she says for some it is their only chance of sticking at a normal weight.

"It is not an easy option but you do get some good results. Afterwards people have told me they feel they are controling their food intake rather than food controlling them. But you still have to be disciplined and adopt new dietary habits.

"We have a lot to do and I think that the government has got to put more pressure on the food industry so people get the right information about the food they are eating . We will also be working hard to make sure that more bariatric surgery is available. In Yorkshire we have about 600 cases a year – one of the highest. But it is only a small fraction of the people who could benefit."

FACTFILE

Official projections suggest nine out of 10 adults and two-thirds of children will be obese or overweight by 2050.

Unless trends are reversed this would cost the economy an extra 50bn – and lead to huge increases in cancer, heart disease and diabetes and knock nine years off life expectancy.

Latest figures show one in six five-year-olds in parts of Yorkshire are obese, rising to a fifth of 10 to 11-year-olds

The Department of Health estimates that around 58 per cent of incidences of type 2 diabetes, 21 per cent of heart disease cases and up to 42 per cent of certain cancers (endometrial, breast, and colon) are attributable to excess body weight.

It has been estimated that the cost of obesity to the NHS in the UK is already around 4.2 billion and it is predicted that this will more than double by 2050.

It is also estimated that weight problems already cost the wider economy in the region of 16 billion and that this will rise to 50 billion per year by 2050 if left unchecked.

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